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Strategic Priorities to Increase Use of Clinical Preventive Services Among Older US Adults

The flow chart depicts the process used to derive 11 priority strategies to increase the use of clinical preventive services and outlines the methods and participation rates for Phase 1 and Phase 2 of the project. Phase 1 is represented by the 3 boxes on the left-hand side of the figure that are linked together with 2 one-way arrows linking boxes 1 to 2 and 2 to 3. The first box states that Phase 1 involved 25 structured discussions. The second box describes the strategy generation process, indicating that the discussions focused on strategies to enhance community capacity for clinical preventive services outreach, delivery, and follow-up, specifically focusing on overcoming barriers and opportunities related to administrative rules, policies, or innovations. The third box highlights the thematic analysis of strategies that included discrete topic alignment and refinement of strategies: development of statements, editing for clarity and independence to prevent overlap or duplication of strategies for Delphi process. The third box in the left-hand column has a dotted line that runs to the second box on the right hand column of Phase 2.

Phase 2 is represented by 6 boxes on the right-hand side of the figure. There are 4 main boxes linked together by single arrows. Two boxes on the side intersect the lines between boxes 2 and 3 and between boxes 3 and 4. Box 1 describes Phase 2 as an online Delphi process. Box 2 indicates that the 27 strategies determined through Phase 1 were used for round 1 in Phase 2. Box 2 has a single arrow to Box 3 that refers to round 2, which used the 17 strategies for round 2 of the Delphi process. Between boxes 2 and 3 is an arrow with a side box. This side box details the stakeholder ratings for round 1 of the Delphi process, a 5-point scale for 2 rating dimensions, which were: 1) impact to increase access and use of preventive services in the community setting in 2 to 3 years and 2) achievability to increase access to and use of preventive services in the community setting in 2 to 3 years. Between boxes 3 and 4 is an arrow to a side box that describes the stakeholder ranking of the top 10 strategies. Participants were instructed to rank strategies (1 through 10) on the basis of each strategy’s potential for greatest measureable impact on increasing the use of preventive services among adults through community settings in the next 3 years. The final box on the right-hand side shows that after round 2, 11 priority strategies remained.

Figure. Methods and participation rates for Phase 1 (May to August 2010) and 2 rounds of an online Delphi process (9), Phase 2 (November 2010 to January 2011), to derive 11 priority strategies to increase the use of clinical preventive services.

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